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All you need is a little sunshine for healthy bones

Irritability, muscle cramps or convulsions, do not dismiss them casually as it could well be an indicator of low levels of the essential vitamin D — which makes your bones stronger. Rhythma Kaul and Nisha Shroff report.

health and fitness Updated: Aug 24, 2013 23:57 IST
Vitamin D

Irritability, muscle cramps or convulsions, do not dismiss them casually as it could well be an indicator of low levels of the essential vitamin D — which makes your bones stronger.

Despite enough sunshine, vitamin D deficiency is affecting people across India, especially young men and women. Of late, tests have increasingly showed that most people — even young people in their teens and twenties, when maximum bone-building happens — are hugely deficit in the vital vitamin.

Banker Yashodhar Pujari, 33, a Mumbai resident, says he developed a breathing problem three years ago. What seemed pretty innocuous to him turned out to be unexpected: he was severely deficient in vitamin D. Against a normal level of 30 ng/ml, his level was just 7. “It was something I had never expected,” he says.

Over the next two months, Pujari, who mainly works indoors, was told to expose himself to direct sunlight for a minimum of 20 minutes per day and was prescribed vitamin supplements. Now, “my vitamin D is 31,” he says.

“I come across at least one patient daily who suffers from this deficiency,” says Dr Anil Ballani, consultant physician at Mumbai’s PD Hinduja and Lilavati hospitals. “This is mainly because people are working indoors all day, in air-conditioned offices, and now also choosing indoor activities for their leisure time.”

Although exposure to sunlight shouldn’t be an issue for residents of India, doctors say a steadily growing number are being treated for vit D deficiencies caused by the lack of exposure to sunlight.

Doctors say that the deficiency has become so common that if they could they would start prescribing the blood test — 25 hydroxy vitamin D — to check vitamin D levels routinely.

“The prolonged deficiency impacts the bone health because the deposition of calcium in the bone is mediated and facilitated by vitamin D. Young people who are vitamin D deficient may suffer from severe bone disease very early in life,” said Dr Rajesh Malhotra, professor, department of orthopaedics, All India Institute of Medical Sciences (AIIMS).Common symptoms include backaches, muscle cramps, weakened muscles, fractures with mild trauma, tiredness, and a general lack of interest.

While fair-skinned people need half an hour of morning sun exposure most days of the week, olive and dark-skinned people need at least three to six times this much to maintain their vitamin levels. Doctors recommend vitamin D supplementation as the best way to get rid of the deficiency.

Dark skin prevents a lot of radiation absorption and it is the cholesterol under the skin that gets converted into vitamin D, which is why old persons are prone to weak bones as they don’t have much fat under the skin.

“Vitamin D is actually a hormone that is known to cause muscular-skeletal problems if there’s defficiency.However, it’s being explored for other health conditions also, which is yet to be proven though” said Dr Nikhil Tandon, professor, department of endocrinology and metabolism, AIIMS. The process of vitamin D synthesis takes about 45 minutes, and the best time is between 10am and 2pm, with head, face, limbs and upper part of the body exposed to direct sunlight.

“It has to be done without break as the whole process gets reversed if you leave the sun even for 5min. That is why taking supplements, either medicines or fortified food-items, is far easier,” said Dr Malhotra.

“All Indian studies uniformly point to low 25(OH)D levels in the populations studies despite abundant sunshine. All studies have uniformly documented low dietary calcium intake compared to Recommended Daily/Dietary Allowances (RDA) by Indian Council of Medical Research (ICMR). The vitamin D status of children is very low in both urban and rural population studied. Pregnant women and their new born had low vitamin D status…” stated a review article published in 2009: Vitamin D Status in India - Its Implications and Remedial Measures (http:// www.japi.org/january_2009/R-1.html).

“Vitamin D deficient women have either premature babies or babies with retarted growth inside the womb, weak bones or have bow-shaped legs at birth,” said Dr Tripat Choudhary, senior consultant, department of obstetrics and gynaecology at New Delhi's Fortis La Femme.

Vitamin D supplementation is continued for about three months in the form of tablets or sachets, and later they are put on a maintenance dose for about a year every day. “An overdose of Vitamin D tablets or injections can lead to kidney failure and other ailments,” says Dr Pratit Sambhani, associate professor at Mumbai’s Jaslok, Breach Candy and Bhatia hospitals. “Take the vitamin tablets with a cup of milk, and follow it with a walk outdoors during sunlight, under the guidance of a doctor.”

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